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Published online by Cambridge University Press:  30 March 2015

Bjørn Hofmann
University College of Gjøvik and University of Oslo,
Irina Cleemput
Hasselt University and Belgian Health Care Knowledge Centre (KCE)
Kenneth Bond
Canadian Agency for Drugs and Technologies in Health
Tanja Krones
University Hospital/University of Zürich
Sigrid Droste
Institute for Quality and Efficiency in Healthcare (IQWiG)
Dario Sacchini
Institute of Bioethics, “Agostino Gemelli” School of Medicine, Universita Cattolica del Sacro Cuore
Wija Oortwijn
Ecorys Netherlands


Background: Although value issues are increasingly addressed in health technology assessment (HTA) reports, HTA is still seen as a scientific endeavor and sometimes contrasted with value judgments, which are considered arbitrary and unscientific. This article aims at illustrating how numerous value judgments are at play in the HTA process, and why it is important to acknowledge and address value judgments.

Methods: A panel of experts involved in HTA, including ethicists, scrutinized the HTA process with regard to implicit value judgments. It was analyzed whether these value judgments undermine the accountability of HTA results. The final results were obtained after several rounds of deliberation.

Results: Value judgments are identified before the assessment when identifying and selecting health technologies to assess, and as part of assessment. They are at play in the processes of deciding on how to select, frame, present, summarize or synthesize information in systematic reviews. Also, in economic analysis, value judgments are ubiquitous. Addressing the ethical, legal, and social issues of a given health technology involves moral, legal, and social value judgments by definition. So do the appraisal and the decision-making process.

Conclusions: HTA by and large is a process of value judgments. However, the preponderance of value judgments does not render HTA biased or flawed. On the contrary they are basic elements of the HTA process. Acknowledging and explicitly addressing value judgments may improve the accountability of HTA.

Copyright © Cambridge University Press 2015 

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1. Arellano, LE, Willett, JM, Borry, P. International survey on attitudes toward ethics in health technology assessment: An exploratory study. Int J Technol Assess Health Care. 2011;27:5054.CrossRefGoogle Scholar
2. Wallay, T. Health technology assessment in England: Assessment and appraisal. Med J Aust. 2007;187:283285.Google Scholar
3. Putnam, H. The collapse of the fact/value dichotomy and other essays. Cambridge, MA: Harvard University Press; 2002.Google Scholar
4. Hennen, L. Biomedical and bioethical issues in parliamentary TA and in health technology assessment. Poiesis Prax. 2004;2:207220.CrossRefGoogle Scholar
5. Flyvbjerg, B. Making social science matter: Why social inquiry fails and how it can succeed again. Cambridge: University of Cambridge; 2001.CrossRefGoogle Scholar
6. Meggle, G, Nida-Rümelin, J (Eds.). [Actions, norms, values: Discussions with Georg Henrik von Wright]. Berlin: de Gruyter; 1999.CrossRefGoogle Scholar
7. Molewijk, B, Stiggelbout, AM, Otten, W, Dupuis, HM, Kievit, J. Implicit normativity in evidence-based medicine: A plea for integrated empirical ethics research. Health Care Anal. 2003;11:6992.CrossRefGoogle ScholarPubMed
8. Hofmann, B. Toward a procedure for integrating moral issues in health technology assessment. Int J Technol Assess Health Care. 2005;21:312318.CrossRefGoogle Scholar
9. Hofmann, B. On value-judgements and ethics in health technology assessment. Poiesis Prax. 2005;3:277295.CrossRefGoogle Scholar
10. Nord, E. Cost-value analysis in health care: Making sense out of QALYs. Cambridge: Cambridge University Press; 1999.CrossRefGoogle Scholar
11. Cookson, R, Drummond, M, Weatherly, H. Explicit incorporation of equity considerations into economic evaluation of public health interventions. Health Econ Policy Law. 2009;4 (pt 2):231245.CrossRefGoogle ScholarPubMed
12. Johri, M, Norheim, OF. Can cost-effectiveness analysis integrate concerns for equity? Systematic review. Int J Technol Assess Health Care. 2012;28:125132.CrossRefGoogle ScholarPubMed
13. Culyer, AJ. Perspective and desire in comparative effectiveness research: The relative unimportance of mere preferences, the central importance of context. Pharmacoeconomics. 2010;28:889897.CrossRefGoogle Scholar
14. Schwappach, DL. Resource allocation, social values and the QALY: A review of the debate and empirical evidence. Health Expect. 2002;5:210222.CrossRefGoogle ScholarPubMed
15. Burls, A, Caron, L, de Langavant, GC, et al. Tackling ethical issues in health technology assessment: A proposed framework. Int J Technol Assess Health Care. 2011;27:230237.CrossRefGoogle ScholarPubMed
16. Droste, S, Rixen, S. [Information on legal issues in health technologies: Methodological proposal to identify them in a systematic and comprehensible manner]. Z Evid Fortbild Qual Gesundhwes. 2012;106:509522.CrossRefGoogle Scholar
17. Hofmann, B. Why ethics should be part of health technology assessment. Int J Technol Assess Health Care. 2008;24:423429.CrossRefGoogle ScholarPubMed
18. European Network for Health Technology Assessment EUnetHTA, The HTA Core Model*: Version 2.0. Helsinki: National Institute for Health and Welfare (THL); 2013. (accessed February 11, 2015).Google Scholar
19. Velasco Garrido, M, Borlum Kristensen, F, Palmhoj Nielsen, C, Busse, R. Health technology assessment and health policy-making in Europe. Geneva: World Health Organization on behalf of the European Observatory on Health Systems and Policies; 2008.Google Scholar
20. Green, C. Considering the value associated with innovation in health technology appraisal decisions (deliberations): A NICE thing to do? Appl Health Econ Health Policy. 2010;8:15.CrossRefGoogle Scholar
21. Oortwijn, WJ, van der Wilt, GJ. [Distributive justice and health technology assessment in the Netherlands: Analysis of six projects funded within the Fund for Investigative Medicine]. Nijmegen: Universitair Medisch Centrum St Radboud, Afdeling MTA; 2003.Google Scholar
22. Tunis, SR. Reflections on science, judgment, and value in evidence-based decision making: A conversation with David Eddy. Health Aff (Millwood). 2007;26:w500w515.CrossRefGoogle Scholar
23. Hoedemaekers, R, Oortwijn, W. Problematic notions in Dutch health care package decisions. Health Care Anal. 2003;11:287294.CrossRefGoogle ScholarPubMed
24. Klein, R, Day, P, Redmayne, S. Managing scarcity: Priority setting and rationing in the National Health Service. Buckingham: Open University Press; 1996.Google Scholar
25. Bombard, Y, Abelson, J, Simeonov, D, Gauvin, FP. Eliciting ethical and social values in health technology assessment: A participatory approach. Soc Sci Med. 2011;73:135144.CrossRefGoogle Scholar